Remote Neurosurgical Training Using Virtual Reality Simulation for the Endoscopic Endonasal Approach to Pituitary Tumors

Background: The use of simulation and virtual reality (VR) is a valuable and innovative way to enhance and supplement technical and non-technical skills acquisition and to overcome the many challenges faced by surgical training programs. The objective of this study is to present a remote training model of the Endoscopic Endonasal Approach (EEA) for pituitary tumor resection using VR simulation. Methods: Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create a three-dimensional digital model of endonasal anatomy in a patient with a pituitary macroadenoma. A 3D video was developed using the 3DS Max program. This study is divided into three parts. The first section discusses the VR model development; the second considers the VR application as used in an online course for neurosurgery residents; and the third appraises the scientific validation of the simulation as a potential beneficial educational tool. All participants completed a questionnaire (using 5-point Likert scales) to rate the realism and utility of the model for learning purposes. Results: Twelve neurosurgery residents were evaluated at the beginning of the course and at the end, after using the VR simulator. The rate of correct answers was calculated before and after the course. The virtual simulator has been shown to be effective for educational purposes. Conclusions: Virtual simulation provided an effective way to present 3D information and to teach surgical anatomy and operative strategies in the EEA. The combination of this tool with an online platform course may provide a valuable alternative teaching method.